{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:46:35Z","timestamp":1792028795609,"version":"4.4.0"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Surg Int"],"DOI":"10.1007\/s00383-026-06663-5","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:40:05Z","timestamp":1792028405000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Childhood Inguinal, Femoral, and Abdominal Hernias in Low-Income Countries: Trends, Inequalities, and Projections to 2050"],"prefix":"10.1007","volume":"42","author":[{"given":"Xinjia","family":"Gu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihui","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jihua","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenwen","family":"Lv","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9259-4998","authenticated-orcid":false,"given":"Taixiang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"key":"6663_CR1","doi-asserted-by":"publisher","first-page":"484","DOI":"10.1503\/cmaj.070923","volume":"27","author":"J G\u00f6deke","year":"2017","unstructured":"Zamakhshary M, To T, Guan J, Langer JC. Risk of incarceration of inguinal hernia among infants and young children awaiting elective surgery. CMAJ. 2008;179:1001\u20131005. https:\/\/doi.org\/10.1503\/cmaj.070923","journal-title":"Eur J Pediatr Surg"},{"key":"6663_CR2","doi-asserted-by":"publisher","first-page":"1357","DOI":"10.1136\/bmjgh-2020-004406","volume":"378","author":"J L\u00f6fgren","year":"2018","unstructured":"PaedSurg Africa Research Collaboration. Paediatric surgical outcomes in sub-Saharan Africa: a multicentre, international, prospective cohort study. BMJ Glob Health. 2021;6:e004406. https:\/\/doi.org\/10.1136\/bmjgh-2020-004406","journal-title":"N Engl J Med"},{"key":"6663_CR3","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1007\/s00383-016-3957-3","volume":"28","author":"C Martucci","year":"2024","unstructured":"Butler EK, Tran TM, Fuller AT, et al. Quantifying the pediatric surgical need in Uganda: results of a nationwide cross-sectional, household survey. Pediatr Surg Int. 2016;32:1075\u20131085. https:\/\/doi.org\/10.1007\/s00383-016-3957-3","journal-title":"Hernia"},{"key":"6663_CR4","doi-asserted-by":"publisher","unstructured":"Kakembo N, Godier-Furnemont A, Nabirye A, et al. Barriers to Pediatric Surgical Care in Low-Income Countries: The Three Delays' Impact in Uganda. J Surg Res. 2019;242:193\u2013199. https:\/\/doi.org\/10.1016\/j.jss.2019.03.058","DOI":"10.1016\/j.jss.2019.03.058"},{"key":"6663_CR5","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1097\/JS9.0000000000000217","volume":"97","author":"SA Abdulhai","year":"2017","unstructured":"Ma Q, Jing W, Liu X, et al. The global, regional, and national burden and its trends of inguinal, femoral, and abdominal hernia from 1990 to 2019: findings from the 2019 Global Burden of Disease Study\u2013-a cross-sectional study. Int J Surg. 2023;109:333\u2013342. https:\/\/doi.org\/10.1097\/JS9.0000000000000217","journal-title":"Surg Clin North Am"},{"key":"6663_CR6","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1097\/JS9.0000000000001071","volume":"109","author":"Q Ma","year":"2023","unstructured":"Wang F, Ma B, Ma Q, Liu X. Global, regional, and national burden of inguinal, femoral, and abdominal hernias: a systematic analysis of prevalence, incidence, deaths, and DALYs with projections to 2030. Int J Surg. 2024;110:1951\u20131967. https:\/\/doi.org\/10.1097\/JS9.0000000000001071","journal-title":"Int J Surg"},{"key":"6663_CR7","doi-asserted-by":"publisher","first-page":"1951","DOI":"10.1097\/JS9.0000000000001071","volume":"110","author":"F Wang","year":"2024","unstructured":"World Bank. World Bank Country and Lending Groups. Fiscal year 2027 classification. Available at: https:\/\/datahelpdesk.worldbank.org\/knowledgebase\/articles\/906519-world-bank-country-and-lending-groups. Accessed 4 October 2026.","journal-title":"Int J Surg"},{"key":"6663_CR8","doi-asserted-by":"publisher","first-page":"4335","DOI":"10.1016\/S0140-6736(25)01637-X","volume":"39","author":"X Liu","year":"2025","unstructured":"GBD 2023 Disease and Injury and Risk Factor Collaborators. Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990\u20132023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet. 2025;406:1873\u20131922. https:\/\/doi.org\/10.1016\/S0140-6736(25)01637-X","journal-title":"Surg Endosc"},{"key":"6663_CR9","doi-asserted-by":"publisher","first-page":"109673","DOI":"10.1016\/S0140-6736(25)01917-8","volume":"188","author":"GX Li","year":"2025","unstructured":"GBD 2023 Causes of Death Collaborators. Global burden of 292 causes of death in 204 countries and territories and 660 subnational locations, 1990\u20132023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet. 2025;406:1811\u20131872. https:\/\/doi.org\/10.1016\/S0140-6736(25)01917-8","journal-title":"Surgery"},{"key":"6663_CR10","doi-asserted-by":"publisher","first-page":"e0323790","DOI":"10.1016\/0277-9536(91)90212-U","volume":"20","author":"J Zhang","year":"2025","unstructured":"Wagstaff A, Paci P, van Doorslaer E. On the measurement of inequalities in health. Soc Sci Med. 1991;33:545\u2013557. https:\/\/doi.org\/10.1016\/0277-9536(91)90212-U","journal-title":"PLoS ONE"},{"key":"6663_CR11","doi-asserted-by":"publisher","first-page":"1873","DOI":"10.1016\/S0140-6736(25)01637-X","volume":"406","author":"GBD 2023 Disease and injury and risk factor collaborators","year":"2025","unstructured":"Das Gupta P. Standardization and Decomposition of Rates: A User's Manual. Current Population Reports, P23-186. Washington, DC: US Bureau of the Census; 1993.","journal-title":"Lancet"},{"key":"6663_CR12","doi-asserted-by":"publisher","first-page":"679","DOI":"10.2307\/1913643","volume":"184","author":"T Liu","year":"2025","unstructured":"Koenker R, Bassett G Jr. Regression quantiles. Econometrica. 1978;46:33\u201350. https:\/\/doi.org\/10.2307\/1913643","journal-title":"Eur J Pediatr"},{"key":"6663_CR13","doi-asserted-by":"publisher","first-page":"1811","DOI":"10.1016\/S0169-2070(01)00110-8","volume":"406","author":"GBD 2023 causes","year":"2025","unstructured":"Hyndman RJ, Koehler AB, Snyder RD, Grose S. A state space framework for automatic forecasting using exponential smoothing methods. Int J Forecast. 2002;18:439\u2013454. https:\/\/doi.org\/10.1016\/S0169-2070(01)00110-8","journal-title":"Lancet"},{"key":"6663_CR14","doi-asserted-by":"publisher","unstructured":"Meara JG, Leather AJM, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386:569\u2013624. https:\/\/doi.org\/10.1016\/S0140-6736(15)60160-X","DOI":"10.1016\/S0140-6736(15)60160-X"},{"key":"6663_CR15","doi-asserted-by":"publisher","first-page":"102791","DOI":"10.1371\/journal.pone.0170968","volume":"17","author":"J Zhang","year":"2023","unstructured":"Butler EK, Tran TM, Nagarajan N, et al. Epidemiology of pediatric surgical needs in low-income countries. PLoS One. 2017;12:e0170968. https:\/\/doi.org\/10.1371\/journal.pone.0170968","journal-title":"Diabetes Metab Syndr"},{"key":"6663_CR16","doi-asserted-by":"publisher","first-page":"103051","DOI":"10.1016\/j.jpedsurg.2012.09.030","volume":"80","author":"L Yuan","year":"2025","unstructured":"Ozgediz D, Poenaru D. The burden of pediatric surgical conditions in low and middle income countries: a call to action. J Pediatr Surg. 2012;47:2305\u20132311. https:\/\/doi.org\/10.1016\/j.jpedsurg.2012.09.030","journal-title":"EClinicalMedicine"},{"key":"6663_CR17","doi-asserted-by":"publisher","first-page":"946","DOI":"10.2471\/BLT.18.216028","volume":"160","author":"A Matovu","year":"2025","unstructured":"Mullapudi B, Grabski D, Ameh E, et al. Estimates of number of children and adolescents without access to surgical care. Bull World Health Organ. 2019;97:254\u2013258. https:\/\/doi.org\/10.2471\/BLT.18.216028","journal-title":"JAMA Surg"},{"key":"6663_CR18","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1016\/S2214-109X(15)70087-2","volume":"12","author":"R Ologunde","year":"2014","unstructured":"Rose J, Weiser TG, Hider P, Wilson L, Gruen RL, Bickler SW. Estimated need for surgery worldwide based on prevalence of diseases: a modelling strategy for the WHO Global Health Estimate. Lancet Glob Health. 2015;3(Suppl 2):S13\u2013S20. https:\/\/doi.org\/10.1016\/S2214-109X(15)70087-2","journal-title":"Int J Surg"},{"key":"6663_CR19","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1001\/jama.2024.2302","volume":"18","author":"B Haggui","year":"2021","unstructured":"HIP Trial Investigators. Effect of Early vs Late Inguinal Hernia Repair on Serious Adverse Event Rates in Preterm Infants: A Randomized Clinical Trial. JAMA. 2024;331:1035\u20131044. https:\/\/doi.org\/10.1001\/jama.2024.2302","journal-title":"Afr J Paediatr Surg"},{"key":"6663_CR20","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1007\/s10029-019-01877-0","volume":"28","author":"LF Goodman","year":"2018","unstructured":"Olesen CS, Mortensen LQ, \u00d6berg S, Rosenberg J. Risk of incarceration in children with inguinal hernia: a systematic review. Hernia. 2019;23:245\u2013254. https:\/\/doi.org\/10.1007\/s10029-019-01877-0","journal-title":"Eur J Pediatr Surg"},{"key":"6663_CR21","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1007\/s10029-015-1450-x","volume":"386","author":"JG Meara","year":"2015","unstructured":"Chang SJ, Chen JYC, Hsu CK, Chuang FC, Yang SSD. The incidence of inguinal hernia and associated risk factors of incarceration in pediatric inguinal hernia: a nation-wide longitudinal population-based study. Hernia. 2016;20:559\u2013563. https:\/\/doi.org\/10.1007\/s10029-015-1450-x","journal-title":"Lancet"},{"key":"6663_CR22","doi-asserted-by":"publisher","first-page":"1416","DOI":"10.1186\/s12893-020-01039-5","volume":"43","author":"Global Initiative for Children\u2019s Surgery","year":"2019","unstructured":"Wang K, Tan SS, Xiao Y, et al. Characteristics and treatments for pediatric ordinary and incarcerated inguinal hernia based on gender: 12-year experiences from a single center. BMC Surg. 2021;21:67. https:\/\/doi.org\/10.1186\/s12893-020-01039-5","journal-title":"World J Surg"},{"key":"6663_CR23","doi-asserted-by":"publisher","first-page":"80","DOI":"10.5334\/aogh.4532","volume":"90","author":"S Mitra","year":"2024","unstructured":"Bickler SW, Rode H. Surgical services for children in developing countries. Bull World Health Organ. 2002;80:829\u2013835.","journal-title":"Ann Glob Health"},{"key":"6663_CR24","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1371\/journal.pone.0205132","volume":"30","author":"M Ohene-Yeboah","year":"2011","unstructured":"Bearden A, Fuller AT, Butler EK, et al. Rural and urban differences in treatment status among children with surgical conditions in Uganda. PLoS One. 2018;13:e0205132. https:\/\/doi.org\/10.1371\/journal.pone.0205132","journal-title":"West Afr J Med"},{"key":"6663_CR25","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1007\/s00268-018-04884-x","volume":"58","author":"EA Ameh","year":"2023","unstructured":"Garber K, Ram\u00edrez Cabrera CC, Dinh QL, et al. The Heterogeneity of Global Pediatric Surgery: Defining Needs and Opportunities Around the World. World J Surg. 2019;43:1404\u20131415. https:\/\/doi.org\/10.1007\/s00268-018-04884-x","journal-title":"J Pediatr Surg"},{"key":"6663_CR26","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1016\/S0140-6736(24)00103-X","volume":"37","author":"JO Seyi-Olajide","year":"2021","unstructured":"ASOS-Paeds Investigators. Outcomes after surgery for children in Africa (ASOS-Paeds): a 14-day prospective observational cohort study. Lancet. 2024;403:1482\u20131492. https:\/\/doi.org\/10.1016\/S0140-6736(24)00103-X","journal-title":"Pediatr Surg Int"},{"key":"6663_CR27","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1016\/j.jpedsurg.2015.02.031","volume":"29","author":"N Chen","year":"2025","unstructured":"Livingston MH, DCruz J, Pemberton J, Ozgediz D, Poenaru D. Mortality of pediatric surgical conditions in low and middle income countries in Africa. J Pediatr Surg. 2015;50:760\u2013764. https:\/\/doi.org\/10.1016\/j.jpedsurg.2015.02.031","journal-title":"Hernia"},{"key":"6663_CR28","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1007\/s00268-014-2818-2","volume":"33","author":"F Taverner","year":"2023","unstructured":"Eeson G, Birabwa-Male D, Pennington M, Blair GK. Costs and cost-effectiveness of pediatric inguinal hernia repair in Uganda. World J Surg. 2015;39:343\u2013349. https:\/\/doi.org\/10.1007\/s00268-014-2818-2","journal-title":"Paediatr Anaesth"},{"key":"6663_CR29","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1371\/journal.pone.0165480","volume":"21","author":"K Wang","year":"2021","unstructured":"Saxton AT, Poenaru D, Ozgediz D, Ameh EA, Farmer D, Smith ER, et al. Economic Analysis of Children's Surgical Care in Low- and Middle-Income Countries: A Systematic Review and Analysis. PLoS One. 2016;11:e0165480. https:\/\/doi.org\/10.1371\/journal.pone.0165480","journal-title":"BMC Surg"},{"key":"6663_CR30","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1053\/j.sempedsurg.2015.09.003","volume":"41","author":"S Williams","year":"2025","unstructured":"Hsiung G, Abdullah F. Financing pediatric surgery in low-, and middle-income countries. Semin Pediatr Surg. 2016;25:10\u201314. https:\/\/doi.org\/10.1053\/j.sempedsurg.2015.09.003","journal-title":"Pediatr Surg Int"},{"key":"6663_CR31","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/S2214-109X(15)70085-9","volume":"39","author":"NA Sitkin","year":"2015","unstructured":"Shrime MG, Dare AJ, Alkire BC, O'Neill K, Meara JG. Catastrophic expenditure to pay for surgery worldwide: a modelling study. Lancet Glob Health. 2015;3(Suppl 2):S38\u2013S44. https:\/\/doi.org\/10.1016\/S2214-109X(15)70085-9","journal-title":"World J Surg"},{"key":"6663_CR32","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1016\/j.surg.2023.05.010","volume":"28","author":"JM Friedman","year":"2013","unstructured":"Yap A, Olatunji BT, Negash S, et al. Out-of-pocket costs and catastrophic healthcare expenditure for families of children requiring surgery in sub-Saharan Africa. Surgery. 2023;174:567\u2013573. https:\/\/doi.org\/10.1016\/j.surg.2023.05.010","journal-title":"Int J Health Plann Manage"},{"key":"6663_CR33","doi-asserted-by":"publisher","first-page":"e0000220","DOI":"10.1371\/journal.pmed.1000243","volume":"2","author":"KR Landrum","year":"2022","unstructured":"Galukande M, von Schreeb J, Wladis A, et al. Essential Surgery at the District Hospital: A Retrospective Descriptive Analysis in Three African Countries. PLoS Med. 2010;7:e1000243. https:\/\/doi.org\/10.1371\/journal.pmed.1000243","journal-title":"PLOS Glob Public Health"},{"key":"6663_CR34","doi-asserted-by":"publisher","first-page":"100830","DOI":"10.1371\/journal.pmed.1000242","volume":"39","author":"RX Qin","year":"2023","unstructured":"Kruk ME, Wladis A, Mbembati N, et al. Human Resource and Funding Constraints for Essential Surgery in District Hospitals in Africa: A Retrospective Cross-Sectional Survey. PLoS Med. 2010;7:e1000242. https:\/\/doi.org\/10.1371\/journal.pmed.1000242","journal-title":"Lancet Reg Health West Pac"},{"key":"6663_CR35","doi-asserted-by":"publisher","first-page":"760","DOI":"10.3389\/fped.2023.1189676","volume":"35","author":"A Calisti","year":"2011","unstructured":"Gajewski J, Pittalis C, Borgstein E, et al. Critical shortage of capacity to deliver safe paediatric surgery in sub-Saharan Africa: evidence from 67 hospitals in Malawi, Zambia, and Tanzania. Front Pediatr. 2023;11:1189676. https:\/\/doi.org\/10.3389\/fped.2023.1189676","journal-title":"World J Surg"},{"key":"6663_CR36","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1007\/s00268-014-2868-5","volume":"18","author":"ER Smith","year":"2018","unstructured":"Okoye MT, Ameh EA, Kushner AL, Nwomeh BC. A pilot survey of pediatric surgical capacity in West Africa. World J Surg. 2015;39:669\u2013676. https:\/\/doi.org\/10.1007\/s00268-014-2868-5","journal-title":"BMC Health Serv Res"},{"key":"6663_CR37","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1053\/j.sempedsurg.2015.09.007","volume":"21","author":"EA Elhalaby","year":"2012","unstructured":"Krishnaswami S, Nwomeh BC, Ameh EA. The pediatric surgery workforce in low- and middle-income countries: problems and priorities. Semin Pediatr Surg. 2016;25:32\u201342. https:\/\/doi.org\/10.1053\/j.sempedsurg.2015.09.007","journal-title":"Semin Pediatr Surg"},{"key":"6663_CR38","doi-asserted-by":"publisher","unstructured":"Samuel JC, Tyson AF, Mabedi C, et al. Development of a ratio of emergent to total hernia repairs as a surgical capacity metric. Int J Surg. 2014;12:906\u2013911. https:\/\/doi.org\/10.1016\/j.ijsu.2014.07.019","DOI":"10.1016\/j.ijsu.2014.07.019"},{"key":"6663_CR39","doi-asserted-by":"publisher","unstructured":"Goodman LF, St-Louis E, Yousef Y, et al. The Global Initiative for Children's Surgery: Optimal Resources for Improving Care. Eur J Pediatr Surg. 2018;28:51\u201359. https:\/\/doi.org\/10.1055\/s-0037-1604399","DOI":"10.1055\/s-0037-1604399"},{"key":"6663_CR40","doi-asserted-by":"publisher","unstructured":"Seyi-Olajide JO, Anderson JE, Kaseje N, et al. Inclusion of Children's Surgery in National Surgical Plans and Child Health Programmes: the need and roadmap from Global Initiative for Children's Surgery. Pediatr Surg Int. 2021;37:529\u2013537. https:\/\/doi.org\/10.1007\/s00383-020-04813-x","DOI":"10.1007\/s00383-020-04813-x"},{"key":"6663_CR41","doi-asserted-by":"publisher","unstructured":"Wimmer S, Truche P, Guadagno E, et al. Assessing the inclusion of children's surgical care in National Surgical, Obstetric and Anaesthesia Plans: a policy content analysis. BMJ Open. 2023;13:e051248. https:\/\/doi.org\/10.1136\/bmjopen-2021-051248","DOI":"10.1136\/bmjopen-2021-051248"},{"key":"6663_CR42","doi-asserted-by":"publisher","unstructured":"Malik M, Bandyopadhyay S, Hussain NSF, et al. Improving Access to Pediatric Surgery in LMICs Through Capacity-Building: A Systematic Review. Pediatrics. 2025;156:e2025072119. https:\/\/doi.org\/10.1542\/peds.2025-072119","DOI":"10.1542\/peds.2025-072119"}],"container-title":["Pediatric Surgery International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00383-026-06663-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00383-026-06663-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00383-026-06663-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:40:06Z","timestamp":1792028406000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00383-026-06663-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,14]]},"references-count":42,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["6663"],"URL":"https:\/\/doi.org\/10.1007\/s00383-026-06663-5","relation":{},"ISSN":["1437-9813"],"issn-type":[{"value":"1437-9813","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,14]]},"assertion":[{"value":"15 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 October 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors have no conflicts of interest or financial ties to disclose.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study is a secondary analysis of de-identified, aggregated data from the publicly available GBD 2023 database, involving no original data collection. It complies with the ethical principles of the Declaration of Helsinki and did not require additional ethical committee review.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"443"}}